CARDIAC DYSRYTHMIAS

PRESENTED BY : ADINA, KRIZEL GUINGAB

SUBMITTED TO : MR. CONCEPCION, CLARENCE JAN

Definition of Terms:

Ablation – purpose destruction of heart muscle cells, usually in an attempt to control a

dysrhythmia.

Antiarrhythmic – a medication that suppresses or prevents a dysrhythmia.

Conductivity – ability of the cardiac muscle to transmit electrical impulses.

Defibrillation – electrical current administered to stop a dysrhythmia.

Depolarization – process by which cardiac muscle cells change from a more negatively

Dysrhythmia (also referred to as arrhythmia) – disorder of the formation or conduction (or

both) of the electrical impulse within the heart, altering the heart rate, heart rhythm, or both
and potentially causing altered blood flow.

Implantable Cardioverter Defibrillator (ICD) – a device implanted into the chest to treat
dysrhythmias.

Inhibited – in reference to pacemakers term used to describe the pacemaker with holding an
impulse (not firing).

PR interval- the part of an ECG that reflects conduction of an electrical impulse from the
sinoatrial (SA) node through the atrioventricular (AV) node.

Proarrthythmic – an agent that causes or exacerbates a dysrhythmia.

QRS complex – the of an ECG that reflects conduction of an electrical impulse through the
ventricles; ventricular depolarization.

QT interval – the part of an ECG that reflects the time from ventricular depolarization to
repolarization.

Repolarization – process by which cardiac muscle cells return to a more negatively charged
intracellular condition, their resting state.

Sinus rhythm – electrical activity of the heart initiated by the sinoartrial (SA) node.

ST segment – The part of an ECG that reflects the end of ventriocular depolarization (end of the
T wave).
Supraventricular tachycardia (SUT) – a rhythm that originated in the conduction system above
the ventricles.

T wave – the part of an ECG that reflects repolarization of the ventricles.

Triggered – reference to pacemakers, term used to described the release of an impulse in

response to some stimulus.

U wave – the part of an ECG that may reflect purkinje fibe r repolarization.

Ventricular tachycardia (UT) – a rhythm that originated in the ventricles.

 Dysrhythmias
Disorders of the formation or conduction or both of the electrical impulse within the heart.

Disorders can cause disturbances of the heart rate, the heart rhythm or both.
Dysrhythmias may initially be evidenced by the hemodynamic effect they cause (e.g. a change
inconduction may change the pumping action of the heart and cause decreased blood pressure.

Dysrhythmias are diagnosed by analyzing the electrocardiographic waveform.

Types of Dysrhythmias
Dysrhythmias include sinus node, atrial, junctional, and ventricular dysrhythmias and their
various subcategories.

1. SINUS NODE DYSRYTHMIAS

A) Sinus Bradycardia - occurs when the sinus node creates an impulse at a slower – than –
normal rate.

Cause:
Lower metabolicneeds (sleep, athletic training, hypothermia, hypothyroidism)
Vagal Stimulation (vomiting, suctioning, severe pain, extreme emotions)
Medications (calcium channel blockers, amiodarone, beta- blockers)

Invenced intracranial pressure, and myocardial infarction (MI), especially of the inferior wall.

Characteristics of Sinus bradycardia

-Ventricular & atrial rate : less than 60 in the adult
-Ventricular & atrial rhythm : regular
-QRS shape & duration: Usually normal, but may be regularly abnormal
-P: QRS ration: 1:1

B) Sinus Tachycardia – Sinus tachycardia occurs when the sinus node creates an impulse at a
faster – than – normal rate.

Cause:
Acute blood loss, anemia, shock, hyperrolemia, hypovolemia congestive heart failure, pain,
hypermetabolic states, fever, exercise,anxiety or
sympathomimetic medications

ECG criteria for sinus tachycardia

-Ventricular & atrial rate: greater than 100 in the adult
-Ventricular & atrial rhythm: regular
-QRS shape & duration – usually normal, but may be regularly abnormal
-P wave: normal & consistent shape: always in front of the QRS, but may be buried in the
receding T wave
-P: QRS ratio: 1:1
-PR interval – Consistent interval between 0.12 & 0.20 seconds

Treatment for Sinus tachycardia

Calcium channel blockers & beta- blockers used to reduce the heart rate quickly
C) Sinus Arrhythmia – Sinus arrhythmia occurs when the sinus node creates an impulse at an
irregular rhythm; the rate usually increase with inspiration and decrease with expiration.

Causes:

Nonrespiratory causes include heart disease & valvular disease, but these are rarely seen.

P wave: normal & consistent

shape: always in front of the QRS

PR interval: consistent interval between 0.12 and 0.20 seconds

P: QRS ratio: 1:1

2. ATRIAL DYSRYTHMIAS

A) Premature atrial complex – A premature atrial complex (PAC) is a single ECG complex that
occurs when an electrical impulse starts in the atrium before the next impulse of the sinus node

CAUSES:
caffeine, alcohol, nicotine, stretched atrial myocardium (as in hyperrolemia), anxiety,
hypokalemia (low potassium level), hepermetabolic states, or atrial ischemia, injury or
infarction

Characteristics of PAC’s
-Ventricular and atrial rate: depends on the underlying rhythm (e.g. sinus tachycardia)
-PR interval: The early P wave has a shorter – than – normal PR interval but still between 0.12 &
0.20 seconds
-Ventricular and atrial rhythm: Irregular due to early P waves, creating a PP invertal that is
shorter than the others. This is sometimes followed by a longer – than – normal PP interval, but
one that is less than twice the normal PP interval. This type of interval is called a non
compensatory pause.
-QRS shape and duration: the QRS that follows the early P wave is usually normal, but it may be
adnormal (aberrantly conducted PAC). It may even be absent (blocked PAC)
-P wave: an early and different P wave may be seen or may be hidden in the T wave: other P
waves in the strip are consistent.
-P: QRS ratio: usually 1:1

B) Atrial Flutter – atrial flutter occurs in the atrium and creates impulses at an atrial rate
between 250 & 400 times per minute. Because the atrial rate is faster than the AV node can
conduct, not all trial impulses are conducted into the ventricles.

Causes:
Similar to atrial fibrillation
Characteristics of Atrial Flutters
-Ventricular & Atrial rate: Atrial rates ranges between 250 and 400: ventricular rate usually
ranges between 75 and 150
-Ventricular and Atrial rhythm: The atrial rhythm is irregular because of a change in the AV
conduction
-QRS shape and duration: usually normal, but may be abnomal or may be absent
-P wave: Sawtoothed shape: These waves make it refered to as F waves
-PR interval: multiple F waves may make it difficult to determine the PR interval
-P: QRS ratio: 2:1, 3:1,or 4:1

SIGNS AND SYMPTOMS:

Chest pain, shortness of breath, & lowblood pressure

Treatment:

If patient is unstable
- electro cardioversion

If patient is stable
- Diltiazem (Cardizem)
- Verapamil(Calan, Isoptin)
- Beta-blockers or digitalis
- Flecainide (Tambocor)
- Ibutilide (Corvert)
- Dofetilide (Tikosyn)
- Quinidine(Cardioquin ,
Quinaglute)

C) Atrial Fibrillation – Atrial Fibrillation causes a rapid, disorganized, & uncoordinates twitching
of atrial musculature. It is the most common dysrhythmia that causes patients to seek medical
attention. It may start and stop suddenly.

Characteristics of Atrial Fibrillation

-Ventricular and atrial rate: Atrial rate is 300 to 600. Ventricular rate usually 120 to 200 in
untreated atrial fibrillation
-Ventricular and atrial rhythm: Highly Irregular
-QRS shape & duration: usually normal, but may be abnormal
-P wave: no discernible P waves: Irregular undulating waves are seen and are referred to as
fibrillatory or F waves
-PR interval: cannot be measured
P: QRS ratio: many:1
Symptoms:
-irregular palpitations, fatigue, and malaise

Treatment
-Depends on its cause duration and the patient’s symptom’s, age, and comorbidities
-For Acute Onset
Quinidine, ibutilide, flecanide, dofetilide, propafenone
Procainamide (Pronestyl), disopyramide,or amiodarone

3. Junctional Dysrhythmias
A) Premature Junctional Complex – A premature junctional complex is an impulse that starts in
the AV nodal area before the next normal sinus impulse reaches the AV node. Premature
junctional complex include digitalis toxicity, congestive heart failure, and coronary artery
disease.

The ECG criteria for premature junctional complex are the same as for PAC’s, except for the P
wave and the PR interval. The P wave may be absent, may follow the QRS, or may occur before
the QRS but with a PR interval of less than 0.12 seconds. Premature junctional complexes rarely
produce significant symptoms.

Treatment:
Same as for frequent PAC’s
B) Junctional Rhythm – Junctional or idional rhythm occurs when the AV node, instead of the
sinus node slows (from increased vagal slows (from increased vagal tone) or when the impulse.
ECG criteria for Junctional Rhythm
-Ventricular & atrial rate: ventricular rate 40 to 60: atrial rate also 40 to 60 if P waves are
discernible
-Ventricular and Atrial rhythm: regular
-QRS shape and duration: usually normal but may be abnormal
-P wave: may be absent, after the QRS complex, or before the QRS: may be inverted,
especiallyin lead II
-PR interval: If P wave is in front of the QRS, PR interval is less that 0.12 second
-P: QRS ratio: 1:1 or 0:1

Atrioventricular nodal Reentry

Atrioventricular nodal Reentry
Tachycardia – AV nodal reentry
Tachycardia – AV nodal reentry
tachycardia occurs when an
tachycardia occurs when an
impulse is conducted to an area
impulse is conducted to an area
in the AV node that causes the
in the AV node that causes the
impulse to be revouted back into
impulse to be revouted back into
the same area over and over and
the same area over and over and
over again at very fast rate.
over again at very fast rate.

Factors associated with the

Factors associated with the
development of AV nodal reentry
development of AV nodal reentry
caffeine, nicotine, hypoxemia
caffeine, nicotine, hypoxemia
and stress
and stress